Relationship between transformational leadership and quality of nursing work life in hospital

Relationship between transformational leadership and quality of nursing work life in hospital

Abstract                                                                                 

Nursing in hospitals is very critical and therefore requires a high performance for improved health services to clients. Due to many different challenges and situations which nurses undergo in everyday life, the same must have a flexible kind of leadership as there is no specific leadership style that can cater to all these challenges (Özden et al. 2019).  By ensuring the transformational type of leadership in their daily activities for practical and more improved work in hospitals, the leadership challenges can be minimized. The main objective of this study is the determination of the relationship that exists between the Quality of Nursing Work Life (QNWF) and transformational leadership. The strategies used in administration are very critical in enhancing the role of nurses, and leaders should create a productive environment for nurses.

Introduction

The quality of health services in hospitals relies a lot on the quality of the work done by the nurses. Therefore nursing needs to have competent leadership that can increase the productivity performance for the nurses. QNWL indicates that nurses can see the opportunities available in their work environment and are satisfied by the work they do in the hospitals (White et al. 2019). The role of leadership in the nursing field is very critical and should be handled carefully to ensure nurses are highly motivated to take their part in giving the best services o the patients. The leadership in nursing need flexibility due to the different daily situations such as emergency cases patients may require. The quality of the work provided by nurses can be significantly affected by the leadership. Therefore the leaders must be able to understand the difficulties which nurses undergo in everyday life and aim at rewarding and motivating them to keep hard work.

For the nurses to meet job satisfaction, there is a need for the leaders in the field to consider their environmental safety and comfortable atmosphere while ensuring a clear understanding of the desires of the organization. The involvement of the staff and encouraging teamwork in the leadership is very crucial in the administration as each can learn different skills from the other and improve the productivity of the nurses. In many health institutions, the nurses have the most significant number as the employees in those institutions and play a vital role in health organizations (Klemenc-Ketiš & Susič, 2019). The leadership style for the group is hard to define, as there is no suitable leadership style. Thus, the leaders must be sage to incorporate different aspects of different styles to ensure the best results and efficiency of the work done by the nurses. The latter refers to transformational leadership, and all considerations for the quality of the nurses’ work-life must be considered.

Literature

Transformational leadership relates to the quality of nursing work life in many ways, and the main interest of the project will be to determine all these relationships. Transformational leadership involves the incorporation of four critical aspects in administration, which include idealized influence, which is an aspect which leads to the leader having many followers form the organization and leaving a life that can be emulated by the worker (Barkhordari-Sharifabad, & Mirjalili, 2019). The leaders should also reflect the organization’s goals and ensure that they influence the institution, thus acting as a guide to the workers. The leaders need to be good motivators who can motivate their subordinates to work more effectively and feel motivated to take the daily tasks in the profession available in the hospital. The leaders should enquire about the difficulties which the subordinates are going through and try to solve them by intellectual stimulation.

Transformational leaders are responsible for the provision of required assistance, such as resources for the nurses. The performance of the nurses in the institution is in the hands of the leaders, and therefore, leaders need to be very committed to ensure that the goals of the institution have been achieved (Wan et al. 2018). Transformational leaders must be able to provide an energetic atmosphere for the patients and the nurses who will lead to quality care. The moral and ethical behaviour of the leaders should be high and can emulatable by his subordinates. The leaders are responsible for any mistakes and should be very careful to give a productive leadership that is capable of leading to quality work and which has no errors.

Quality of Nursing Work Life is the satisfaction of the employee based on his or her personal feelings and perceptions on the work of the institution. The QNWS has four significant dimensions which include, home work-life dimension, work design dimension, work world dimension, and the effects of changes in the profession dimension (Colduvel, 2017). The homework dimension refers to the life of nurses while at home and in a hospital, while the work design dimension refers to the real work which the nurses do daily in the hospital or health care. The work world dimension is social changes in the environment affecting the life of nurses and the effects which have been caused by these changes in their lives.

The transformational leadership style has a lot to do with ensuring all the dimensions of quality of Nursing Work-life are achieved, thus creation a relationship. The leadership must ensure that the feelings of personal feelings of the nurses while in the wok is positive by ensuring a positive environment and better treatment of the nurses (Bellack & Dickow, 2019). For the leaders in providing such a situation, they must incorporate the aspects of transformational leadership. The leadership in the profession is very complex and requires competent personnel who have relevant leadership skills to ensure that the lives of the nurses are safe and the working atmosphere is safe. Leadership can be done by ensuring that the human needs of the nurses have been met before the nurses go ahead with their jobs (Emran, 2015).

Qualitative study methodology

The qualitative data methods which were used to collect information for the project include a self-report questionnaire, observation, interviews, focus group discussions, and document analysis. These methods would be used to collect data that is necessary for the research, and the information obtained will be integrated to give the final data for the study.

 Questionnaire

The self-report questionnaires, which contain the relevant information on the relationship between the nurses and their leaders, will be issued to different leaders and nurses in various hospitals. The questionnaires will be responded to by several leaders of nurses and nurses from different hospitals. The quizzes for the nurses will be different from those of their leaders since different information will be required from each of them. The questions which will be contained in the questionnaires will be closed-ended to ensure less struggle or irrelevant information provided. Their responses will be obtained and recorded to give the relationship which exists between the leaders and the nurses in different hospitals. The results obtained from the questionnaire will be used to come up with precise information for the research.

Observation

The information will be obtained by moving to different hospitals and observing the activities which will be done by the nurses and their leaders. The operation will be done strategically such that they would not quickly notice whether they will be observed; thus, they will do their activities as usual. Three hospitals will be visited, and the results from the observation will be obtained and analyzed, giving the required information for the research. The view will include the environment in which the nurses will be operating and their reactions to different situations. The facial expressions should be noted, and the nurse’s speech with their leaders recorded. This information will be beneficial when making a comparison with other sources of information.

Interviews

Interviews will be conducted on several different hospitals to various nurses, and their leaders, and the results will be recorded. The relevant questions concerning the relationships between the two groups will be asked orally, and the results obtained and documented. The interview will start with the top leader for the nurses and will later be conducted on the other leaders and the nurses in the different hospitals. For each person, the interview will be held for a maximum of 15 minutes to ensure time-saving for other works. All the data obtained will then be preserved and compared with those of different sources for the final information about the research.

Focus Group Discussion

The focus group discussions will be conducted with the different nurse leaders to discuss the relationship practices with the nurses. Another discussion group will be held separately for the nurses to discuss the matters existing in their relationship with their leaders (Yankovsky,  Gajewski & Dunton, 2016). The questioning for the open forums will be done to ensure that a lot of data has been recorded for comparison and analysis when documenting the research. The nurses would be requested to give their views on how they think they should be treated and how they are treated while in their daily activities. The questioning of their working environment will also be essential, and responses will be recorded. The focus group schedule will be kept straight forward to avoid wastage of time by those involved.

Document analysis

Data will also be obtained through thorough searches of information from books, journals, articles, and other records, which has the information relating to the relationship in the leadership of the nurses and the nurses themselves (Stewart & Halpin, 2019). The required information only will be picked from these sources and should not be having any misleading information about the relationship. The recording of this information from documents shall be well written to avoid inconveniences when doing the data analysis. This information will be gathered and preserved for comparison with the data from other sources.

Sampling Plan

The study will be carried out in some hospitals located in Makassar in Indonesia and hospitals and will be selected randomly to participate in the study. The hospitals that will participate in the survey shall be owned by differently, and therefore the review will contain the data collected from the private and public hospitals in Makassar. The participants will also be selected randomly to volunteer for the study. For quality assessment data, the participants will be asked to sign an informed consent document to verify them as valid participants in the survey (Silva, Candido & Duarte, 2015). The participants will be the nurses form different hospitals in Makassar. For assurance of eligibility of data obtained, the nurses will be chosen based on their work period in their place of work. Therefore the study will be limited to the nurses who have worked in the hospital for more than one year (Adams et al. 2018). A nurse who is at least one year in the specific hospital has higher experience in the leadership strategies and the workload that is faced by nurses in different departments in different seasons of the year. The data collection will be aided by issuing of the questionnaire, which will be distributed to all participants. The survey will comprise both open-ended questions and closed-ended questions on leadership strategies employed in their respective hospitals and the nurse workload in different situations. The data obtained from the five hospitals in Makassar will be used in this study to find the connectivity between QNWL and transformational leadership (Tuan, 2015).

Purpose of the study

QNWL was the satisfaction of nurses in their roles or duties, which is vital to nursing productivity and position in the hospital. The pressure that nurses sometimes undergo in hospitals undermines their productivity rate. The satisfaction measures are based on the nurses’ perception of the situations in work roles and their personal life (Moreira et al. 2015). The project will outline the first phases of QWL as the home/work life. This phase describes what nurses go through in hospitals and homes and their effect on their productivity. The second phase is the work design phase, which gives an insight into what nurses do in hospitals while the work context phase explains how the workplace, that is, the hospital affects patients and nurses. The final stage is the work world, which outlines the social problems and professionalism influence from changes, On the other hand, transformational leadership contributes to the changes which nurses undergo in their place of work determined by their leaders (Valiga, 2019). The difference that works encounter in their area of work is due to the four affections of Transformational leadership. Idealized influence determines the behaviour of a worker by coping from their leaders. The workers’ perception of their leaders’ behaviour determines their practice in the workplace. Inspirational motivation, on the other hand, is supported by the leaders’ effort to deliver morals to the workers through motives (Laukkanen, Leino‐Kilpi & Suhonen, 2016). Intellectual stimulation is another perspective that motivates the morals of the work by triggering their belief to be innovative or creative in the workplace. At the same time, the final strategy is the individualized consideration where leaders influence the workers to move beyond their challenges through a word of advice. Therefore, this study will purpose to establish connectivity between transformational leadership and Quality Nurse Work-Life (QNWL) to improve nurses’ productivity in hospitals.

Data collection

The data collection methods adhered to the ethical consideration by educating the participants on the study and making it clear as a voluntary event that would be allowed for the nurses who would have attained at least one working year in a hospital. The participants will sign an informed consent before being allowed to be part of the research (Lotfi et al. 2018). Questionnaires will be distributed to all participants in the selected hospitals in Makassar, Indonesia. This region can be chosen because it has the most significant number of nurses that have other health workers in 2016, which favours this study. Data collection will be facilitated by the use of cross-sectional quantitative analysis, where the questionnaire will be issued to the qualifiers as participants for the study. The data will be a self-report analysis based on the participants’ experiences and knowledge. The questionnaire will consist of three parts that involve the demographic data section, which contain will contain the personal data of the participants that include age, sexuality, marital status, work status, and tenure, and the final part as levels of participants attained.  The other two sections will be the transformational leadership section (TL) and QNWL section (Salavati et al. 2015). The Multifactor Leadership Questionnaire shall measure the transformed direction in Makassar city regional Hospital. The questionnaire measures the four dimensions of Transformation Leadership, that is, idealized influence, inspirational motivation, intellectual motivation, and individualized consideration. Where the participants will be asked to express their feelings using a Likert Scale where the participants would choose from the 4-pointed scale. The scale of the Likert scale ran 0-4, where 0 insinuated leaders TL not functional at all, while four would frequently mean instead of always (Suratno, 2018). The reliability of this scale will be tested after producing a Cronbach’s alpha, which is higher than 0.70, which is the minimum test for Likert Scale reliability.

On the other hand, Quality of nursing work life scale will be used to assess the performance of QNWL. The questionnaire contains 41 sections, which will bee grouped under the four categories of QNWL, and each article will be rated five points on the Likert Scale from 1-5, where one insinuated strongly disagree while five indicate strongly agree. The higher rating or higher score in the Lakers Scale would indicate high probabilities of QNWL. The Likert Scale in this test will also pass the reliability test by recording higher from baseline 0.7.

Data analysis

The use of descriptive statistics analyzed demographic data were correlational study will be sued to test for normality. However, the variables may not meet the correctional assumption; therefore, Spearman correlation will be applied to the data to establish the connection between the TL and QNWL.

RESULTS

The demographic data will be shown in a table in terms of percentage were the participants who work in military hospitals would be recorded. Others include police hospitals, public hospitals, private hospitals, and university’ teaching hospitals will be recorded respectively. Other features such as age will be recorded, mean value and standard deviation will. Work tenure will be marked, mean value and standard deviation will be obtained

In table 2, the Laker scale used in TL record inspirational motivation as the most rated opinion of the participant with an assumed percentage of 11.39, and its standard deviation is 11.39.

On the other hand, world context is ranked the most as a dimension of QNWL with a rate of 76.87 and its standard deviation as 9.22.(the recordings are estimated and not really to show the relationship. Real data shall be entered after the correct records)

Table 3 shows the format sample of data that correlate both results from TL and QNWL to establish a relationship with the two. The style of TL record p<0.01 with its respective factor r=0.28, which can be expressed in terms of percentage as 28%. Intellectual stimulation has established connectivity with QNWL, recording a value of 34% IC showed a minimum amount of 9.1% with p<0.05.

Table 1: Participant demographic characteristics (n=542)

Demographic                                                 Mean

characteristics                        n (%)                          (±SD)

Age                                                                             30 (±4.67)

Work tenure                                                                7 (±4)

Sex;

Male                            107 (19.7)

Female                         435 (80.3)

Marital Status;

Yes                              396 (73.1)

No                               146 (26.9)

Employment

Situation

Permanent staff           109 (20.1)

Temporary staff          433 (79.9)

Educational Level

Diploma or                              229 (42.3)

lower

Bachelor or high                      313 (57.7)

Table 2: Descriptive results of the measures of TL and QNWL (n = 542)

Variabel                                 Range                                     Mean (SD)

TL                                           10-80                           51-41 (14.04)

II (behavior)                            1-16                             11.35 (3.25)

II (attributed)                          0-16                             9.98 (3.25)

IM                                           1-16                             11.39 (3.33)

IS                                            1-16                             9.03 (3.24)

IC                                            0-16                             9.65 (3.24)

QNWL

Overall                                                105-199                       154.03 (15.42)

Work/Home                            10-35

Life                                                                             26.13 (4.15)

Work Design                           18-45                           32.68 (3.86)

Work Context                                     49-100                         76.87 (9.22)

Work World                            10-25                           18.35 (2.49)

Tabel 3.Spearman Rho correlation between related variabel TL and QNWL Dimension (n = 542)

Variable 1 2 3 4 5 6 7 8 9 10 11

1 1

2 0,88** 1

3 0,89** 0,75** 1

4 0,88** 0,73** 0,82** 1

5 0,82** 0,69** 0,65** 0,66** 1

6 0,67** 0,50** 0,48** 0,49** 0,37** 1

7 0,25** 0,21** 0,21** 0,21** 0,15** 0,21** 1

8 0,27** 0,21** 0,23** 0,26** 0,16** 0,20** 0,48** 1

9 0,15** 0,13** 0,14** 0,12** -0,04 0,28** 0,44** 0,32** 1

10 0,20** 0,15** 0,16** 0,17** 0,03 0,24** 0,48** 0,40** 0,62** 1

11 0,28** 0,22** 0,24** 0,21** 0,091* 0,34** 0,71** 0,62** 0,87** 0,73** 1

TL dimension: 1. TL, 2. II (Attributed), 3. II (Behaviour), 4. IM, 5.IC, 6. IS

QNWL dimension: 7. Work/Home Life, 8. Work Design, 9. Work Context, 10. Work World, 11. QNWL Overall *.p<0.05, **. p<0,01

Discussion

The vision of the relationship will be captivating and pleasing and the hypothesis of the research will be as predicted. Leadership in the nursing field affect the retention and recruitment of nurses to the profession and proper leadership need to be applied to encourage high retention rates. The managers of the nurses in an hospital has a great influence in the institution and they should take their roles seriously by applying the necessary aspects of transformational leadership. Application of such aspects will lead to positive results and the improved production by the nurses will be achieved. The employment situation in the private sector is assumed to be temporally for the nurses and has great emotional influences to survive as a nurse. The employment status is likely to affect the relationship of the nurses and their managers.

Conclusion

In conclusion, the transformational leaders need to be recommended in the nursing profession management as its results seem to be beneficial to the sector. Nursing, commonly known as a  profession with significant challenges as the tasks vary on a daily bases. A leade working as a role model and motivates nurses, among other positive leadership aspects, is likely to lead to the achievement of the goals of the organization.

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